Skin, Hair, and Nails

Centimeter ruler (flexible, clear)

Flashlight with transilluminator

Wood’s lamp (to view fluorescing lesions)

Handheld magnifying lens (optional)

EXAMINATION

Cutaneous Color Changes

TECHNIQUE	FINDINGS
	Pigmented nevi. Nonpigmented striae. Freckles. Birthmarks.
	UNEXPECTED:Dysplastic, precancerous, or cancerous nevi. Chloasma. Unpigmented skin. Generalized or localized color changes. Vascular skin lesions. Vascular changes.
Thickness	EXPECTED:Thickness variations, with eyelids thinnest, areas of rubbing thickest. Calluses on hands and feet.
Thickness	UNEXPECTED:Atrophy. Hyperkeratosis. Corns.
Symmetry	EXPECTED:Bilateral symmetry.
Hygiene	EXPECTED:Clean.
Palpate skin
Moisture	EXPECTED:Minimal perspiration or oiliness. Increased perspiration (associated with activity, environment, obesity, anxiety, excitement) noticeable on palms, scalp, forehead, axillae.
Moisture	UNEXPECTED:Damp intertriginous areas.
Temperature Palpate with dorsal surface of hand or fingers.	EXPECTED:Cool to warm. Bilateral symmetry.
Texture	EXPECTED:Smooth, soft, and even. Roughness resulting from heavy clothing, cold weather, or soap.
Texture	UNEXPECTED:Extensive or widespread roughness.
Turgor and mobility	EXPECTED:Resilience.
Gently pinch skin on forearm or in sternal area, and release.	UNEXPECTED:Failure of skin to return to place quickly.

Inspect and palpate lesions
Size Measure all dimensions. Shape Color Use Wood’s lamp to distinguish fluorescing lesions. Blanching Texture Transilluminate to determine presence of fluid. Elevation/depression Pedunculation Exudate Note color, odor, amount, and consistency of lesion. Configuration Check lesion for annular, grouped, linear, arciform, or diffuse arrangement. Location/distribution Check lesion for generalized/localized, body region, patterns, or discrete/confluent.	UNEXPECTED:See table on pp. 36–39

Primary Skin Lesions

Description	Examples
Macule
Flat, circumscribed area that is a change in skin color; less than 1 cm in diameter	Freckles, flat moles (nevi), petechiae, measles, scarlet fever
Measles. From Habif, 2004.
Papule
Elevated, firm, circumscribed area less than 1 cm in diameter	Wart (verruca), elevated moles, lichen planus
Lichen planus. From Weston et al, 1996.
Patch
Flat, nonpalpable, irregular-shaped macule more than 1 cm in diameter	Vitiligo, port-wine stains, mongolian spots, café au lait spots
Vitiligo. From Weston et al, 1991.
Plaque
Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter	Psoriasis, seborrheic and actinic keratoses
Plaque. From Habif, 2004.
Wheal
Elevated irregular-shaped area of cutaneous edema; solid, transient; variable diameter	Insect bites, urticaria, allergic reaction
Wheal. From Farrar et al, 1992. Only gold members can continue reading. Log In or Register to continue You may also need Breasts and Axillae Male Genitalia Anus, Rectum, and Prostate Head-to-Toe Examination Chest and Lungs Ears, Nose, and Throat Abdomen Neuropathic Ulcers Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Click to share on Google+ (Opens in new window) Like this: Like Loading... Related Tags: Mosby's Physical Examination Handbook Mar 25, 2017 \| Posted by admin in PHYSIOLOGY \| Comments Off on Skin, Hair, and Nails Premium Wordpress Themes by UFO Themes WordPress theme by UFO themes %d bloggers like this: